Brain & spine最新文献

{"title":"Spontaneous, nontraumatic clival cerebrospinal fluid fistula, treated with microscope and titanium mesh. Case report and review of the literature.","authors":"Georgi Krasimirov, Todor Shamov, Tihomir Eftimov, Ivan Todorov, Kiril Romansky","doi":"10.1016/j.bas.2026.106282","DOIUrl":"10.1016/j.bas.2026.106282","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebrospinal fluid fistulas (CSF) are pathological communication between subarachnoid space and outer space. Secondary fistulas are those with known etiology - trauma infection surgery etc. Primary CSF fistulas are those with unknown etiology. Based on the localization most frequent localization of CSF are those in frontal and middle cranial fossa. Spontaneous (primary) clival fistulas are extremely rare - only 46 cases are published until now.</p><p><strong>Research question: </strong>Incidence, demographic and other predisposing factors and best treatment method of spontaneous CSF clival fistulas.</p><p><strong>Materials and methods: </strong>A comprehensive PubMed/MEDLINE search identified reported cases of spontaneous clival CSF fistula. Demographics, clinical presentation, imaging features, repair techniques, and outcomes were extracted and analyzed. We present 50 years old man with two weeks of spontaneous CSF rhinorrhea and meningitis with no history of surgery, trauma or infection.</p><p><strong>Results: </strong>A total of 47 cases were identified. Female predominance was observed (33F/14M) with mean age ∼53.7. Obesity and idiopathic intracranial hypertension were common comorbidities. Multilayer endoscopic reconstruction was the preferred technique; single-layer repair was rare. Multilayered CSFF closing was managed using transnasal transsphenoidal microscopic approach and additional titanium mesh was used with great postoperative results.</p><p><strong>Discussion: </strong>Etiology of primary clival CSFF is still unknown. There are theories based on basial artery pulsations, vertebrobasilar dolichoectasia, Marfan syndrome, clival congenital dysplasia. Plausible theory is osteolysis caused by chronic infection in this area. Despite localization operative endoscopic or microscopic treatment is the gold standard for primary CSF fistulas with excellent outcomes and preventing possible complications.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106282"},"PeriodicalIF":2.7,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A hydroxyapatite-based synthetic bone graft reduces intervertebral motion at 12 months, as measured by CT-RSA, in a porcine model of ACDF.","authors":"Maria Östman, Peter Försth, Olof Sandberg, Odd Höglund, Patricia Hedenqvist, Håkan Engqvist, Michael Pujari-Palmer, Franck Forterre","doi":"10.1016/j.bas.2026.106284","DOIUrl":"10.1016/j.bas.2026.106284","url":null,"abstract":"<p><strong>Introduction: </strong>Pseudarthrosis remains a significant complication after anterior cervical discectomy and fusion (ACDF), often causing revision surgery. Synthetic bone grafts (SBGs) offer an alternative to autografts, but objective methods for assessing intervertebral motion (IVM) are needed. Computed tomography-based radiostereometric analysis (CT-RSA) enables precise measurement of cervical IVM.</p><p><strong>Research question: </strong>Does a hydroxyapatite-based SBG reduce cervical IVM compared with control in a porcine ACDF model measured by CT-RSA?</p><p><strong>Material and methods: </strong>Six adult female mini-pigs underwent two-level cervical anterior discectomy. One defect received a hydroxyapatite-based SBG, and the other served as an empty control. No instrumentation was used. The primary outcome was induced total rotation (TR) between vertebrae during flexion-extension CT at 9 and 12 months, compared using the Wilcoxon matched-pairs signed-rank test. Functional fusion was defined as TR < 1° and compared using exact McNemar test. Median (range) values are presented.</p><p><strong>Results: </strong>At 12 months, median IVM TR was significantly lower at SBG than Control levels (0.2° [0.07-0.5] vs. 1.5° [0.2-5.0], p = 0.031). At 9 months, TR was 0.3° (0.04-1.0) and 0.8° (0.1-2.7), respectively (p = 0.063). Functional fusion rates were higher at SBG levels (5/6 and 6/6 at 9 and 12 months) than at Control levels (3/6 at both time points), although the differences were not statistically significant.</p><p><strong>Discussion and conclusion: </strong>The hydroxyapatite-based SBG was associated with lower IVM at 12 months in this porcine ACDF model. CT-RSA provided an objective method for assessing cervical segmental stability and may be useful for evaluating functional spinal fusion in preclinical studies.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106284"},"PeriodicalIF":2.7,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13507529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for revision surgery due to construct failure after instrumented treatment of pyogenic spondylodiscitis.","authors":"Bilal Younes, Dorothee Mielke, Charlotte Flüh, Veit Rohde, Tammam Abboud","doi":"10.1016/j.bas.2026.106283","DOIUrl":"10.1016/j.bas.2026.106283","url":null,"abstract":"<p><strong>Objective: </strong>Construct failure following instrumented treatment for pyogenic spondylodiscitis remains a significant clinical challenge and is often associated with persistent pain or neurological deterioration requiring revision surgery. This study aimed to identify risk factors for construct failure requiring revision surgery after instrumented treatment of pyogenic spondylodiscitis.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included 355 patients who underwent dorsal spinal instrumentation with or without anterior reconstruction for pyogenic spondylodiscitis at the University Medical Center Göttingen between 2013 and 2022. Construct failure requiring revision surgery was defined as the primary endpoint. Time-to-event analyses were performed using Kaplan-Meier survival estimates and Cox proportional hazards regression models. Baseline predictors included age, Charlson Comorbidity Index (CCI), preoperative C-reactive protein (CRP), and osteoporosis. An extended model additionally incorporated postoperative relapse infection and wound infection.</p><p><strong>Results: </strong>During a mean follow-up of 27 ± 9 months, 48 of 355 patients (13.8%) underwent revision surgery due to construct failure. Revision-free survival was 86.9% at 1 year, 82.7% at 2 years, and 80.9% at 3 years. In the baseline Cox proportional hazards model, a higher CCI (HR 1.08 per point increase, 95% CI 1.00-1.16; p = 0.048) and elevated CRP (HR 1.004 per mg/L increase, 95% CI 1.001-1.007; p = 0.018) were independently associated with an increased hazard of revision surgery due to construct failure.In the extended model, relapse infection emerged as the strongest predictor of revision surgery due to construct failure (HR 11.54, 95% CI 5.05-26.36; p < 0.001), while CCI and preoperative CRP remained significant. Age, osteoporosis, and wound infection were not independently associated with revision surgery due to construct failure.</p><p><strong>Conclusion: </strong>Greater comorbidity burden and elevated preoperative CRP were associated with an increased risk of revision surgery due to construct failure, whereas postoperative relapse infection was strongly associated to revision surgery. Optimized risk stratification and stringent infection control may help to reduce revision risk.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106283"},"PeriodicalIF":2.7,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality among patients with aneurysmal SAH in a nationwide unselected cohort.","authors":"Agnes T Stauning, John Hauerberg, Trine Stavngaard, George F Mkoma, Tina N Munch","doi":"10.1016/j.bas.2026.106257","DOIUrl":"10.1016/j.bas.2026.106257","url":null,"abstract":"<p><strong>Introduction: </strong>Aneurysmal subarachnoid haemorrhage is a severe condition with reported in-hospital mortality ranging from 7.1% to 24.1%, but the term <i>in-hospital mortality</i> is not consistently defined, and methodological limitations persist in studies investigating mortality and potential risk factors for mortality. In Denmark, nearly all patients with aSAH are admitted to a neurosurgical department and recorded in a nationwide registry.</p><p><strong>Research question: </strong>Using nationwide clinical data we aimed to estimate mortality within the primary admission to a neurosurgical department and identify risk factors associated with mortality in an unselected aSAH cohort.</p><p><strong>Material and methods: </strong>All patients with aSAH recorded in the Danish Stroke Registry between January 1st 2017 and August 31st, 2022 were included. Associations between potential risk factors and mortality were examined using univariate and multivariate logistic regression models, adjusting for age, sex and neurosurgical admission. Subgroup analyses were conducted among patients who underwent closure of the aneurysm.</p><p><strong>Results: </strong>The cohort comprised 1374 patients. Overall mortality was 22.0%. Mortality among patients who underwent aneurysm treatment was 11.9%. Lower Glasgow Coma Scale score, higher World Federation of Neurological Surgeons score, higher Fisher scale score, aneurysm size >12 mm, posterior circulation location, rebleeding and cerebral infarction were significantly associated with mortality.</p><p><strong>Discussion and conclusion: </strong>In conclusion, this nationwide clinical register-based study showed that mortality after aSAH remained substantial, with 22.0% among all patients admitted to a neurosurgical department in Denmark and 11.9% among those who underwent closure of the aneurysm. Mortality was mainly related to initial clinical severity and complications rather than pre-existing comorbidity.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106257"},"PeriodicalIF":2.7,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous perampanel for early post-traumatic seizure prophylaxis across a wide range of traumatic brain injury severity: Potential for low incidence and favorable outcomes in a retrospective cohort.","authors":"Yuichi Fujiyama, Eiichi Suehiro, Kohei Haji, Koki Okazaki, Hideyuki Ishihara","doi":"10.1016/j.bas.2026.106276","DOIUrl":"10.1016/j.bas.2026.106276","url":null,"abstract":"<p><strong>Introduction: </strong>Early post-traumatic seizures (EPTS) are a significant complication of traumatic brain injury (TBI) that impairs neurological recovery. Perampanel (PER), a selective AMPA receptor antagonist, is a promising prophylactic agent with neuroprotective potential, but its intravenous use in mixed-severity TBI remains unexplored.</p><p><strong>Research question: </strong>We evaluated EPTS incidence and clinical outcomes in TBI patients of all severities receiving intravenous PER as the sole prophylactic agent within 12 h of injury.</p><p><strong>Material and methods: </strong>This single-center, retrospective study included 75 patients with TBI (GCS 3-15) who received intravenous PER 2 mg within 12 h of injury (May 2024-December 2025). The primary outcome was EPTS incidence within 7 days; secondary outcomes included seizure characteristics, GOS-E, late seizures, mortality, and adverse events.</p><p><strong>Results: </strong>EPTS occurred in five patients (6.7%; 95% CI, 2.88%-14.68%); all seizures were convulsive, with none identified as non-convulsive. EPTS patients had lower GCS scores (median 4 vs. 12; p = 0.03), longer mechanical ventilation (p = 0.024), extended ICU/HCU stays (p = 0.031), and lower GOS-E at discharge and 3 months (favorable: 40% vs. 84.4%; p = 0.043); 81.2% of 69 followed patients achieved favorable GOS-E at 3 months. Late seizures occurred in 4.3%, and one patient (1.3%) had a PER-related adverse event, with no psychiatric events.</p><p><strong>Discussion and conclusion: </strong>Intravenous PER within 12 h of TBI was associated with low EPTS incidence, favorable outcomes, and few adverse events. Given the retrospective, single-arm design and modest sample size, these preliminary, hypothesis-generating findings warrant evaluation in the ongoing PEACE-TBI trial.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106276"},"PeriodicalIF":2.7,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of life and work status in patients treated for neurogenic thoracic outlet syndrome via the microsurgical supraclavicular approach - an observational study.","authors":"J Alsolivany, J Reinsch, T A Sargut, S Baruchi, N F Dengler","doi":"10.1016/j.bas.2026.106266","DOIUrl":"10.1016/j.bas.2026.106266","url":null,"abstract":"<p><strong>Objective: </strong>Neurogenic thoracic outlet syndrome (nTOS) is a diagnostic and therapeutic challenge. Recently, consensus statements were developed within the neurosurgical community to improve diagnosis, classification and therapy. However, a standardized outcome assessment according to a validated Quality of life (QoL) questionnaire and has never been performed in patients surgically treated according to the consented recommendations.</p><p><strong>Objective: </strong>To provide systematic information about QoL based on a validated questionnaire and work status in patients surgically treated for nTOS via the supraclavicular approach without routine first rib resection.</p><p><strong>Methods: </strong>Patients surgically treated for nTOS between January 1, 2015, and June 30, 2023 were included. A systematic outcome evaluation using the EQ-5D-5L and a structured interview was performed.</p><p><strong>Results: </strong>The final analysis included 18 patients (median age 39.5 years [45-34], 71% female), of which 94.4% showed a benefit from surgery after a median follow-up (FU) of 1.7 years (IQR 0,7-3). Pain scores on the numerical rating scale (NRS from 0 to 10) significantly improved from 8 (IQR 9-8) to 4 (IQR 5-4) at FU (p < 0.001). The individual health-related QoL on a scale from 0 to 100 was rated with a median of 65 (IQR 50-75) before surgery and 85 (IQR 80-95) at FU (p < 0.001). Five dimensions (mobility/self-care/usual activities/pain/anxiety) were rated on scales from 1 (no problems) to 5 (inability to perform tasks) resulting in median values of 3/3/4/3/3 before surgery and of 2/2/2/2/1 at FU. Patient absence from work due to sick leave decreased from 44% to 18% at FU (p = 0.02).</p><p><strong>Conclusion: </strong>Consensus-based patient management in nTOS led to a significant benefit in terms of pain relief and individual health-related QoL. After surgery, return to work increased significantly.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106266"},"PeriodicalIF":2.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical universality in medicine: A critical rational bioethics beyond cultural relativism.","authors":"Nicolás Samprón, Naci Balak, Jehuda Soleman, Tiit Mathiesen, Marike Broekman, Mario Ganau","doi":"10.1016/j.bas.2026.106268","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106268","url":null,"abstract":"<p><strong>Introduction: </strong>Cultural diversity in healthcare raises a central question: are ethical obligations in medicine universal or culturally dependent? While modern medicine presupposes moral equality, cultural relativism challenges the universality of ethical standards.</p><p><strong>Materials and methods: </strong>Conceptual and historical analysis of medical ethics. The major ethical codes and dominant frameworks: cultural relativism, common morality, and reflective equilibrium were critically examined to assess how ethical norms develop and how ethical judgments are evaluated.</p><p><strong>Results: </strong>Ethical progress in medicine is better explained by the recognition and correction of error than by the convergence of cultural beliefs. Cultural relativism is incompatible with moral equality and risks undermining consistent patient protection. Existing frameworks provide limited accounts of ethical knowledge development. A problem-driven, critical model, \"Critical Rational Bioethics\", is proposed, in which ethical judgments are treated as conjectures subjected to systematic scrutiny and revision.</p><p><strong>Discussion and conclusion: </strong>Ethical universalism follows from moral equality and is incompatible with cultural relativism. Ethical progress in medicine is best understood as the correction of error rather than the justification or convergence of beliefs. Critical Rational Bioethics provides a problem-driven, fallibilist framework in which ethical judgments are critically assessed and provisionally retained. This approach reconciles universal ethical obligations with context-sensitive implementation, supporting consistent patient protection in multicultural clinical settings.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106268"},"PeriodicalIF":2.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13486857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-arterial nimodipine and outcomes in delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.","authors":"Emilia K Pesonen, Sonja Portin, Tommi K Korhonen, Juha-Matti Isokangas, Mikael von Und Zu Fraunberg, Cheng Qian","doi":"10.1016/j.bas.2026.106281","DOIUrl":"10.1016/j.bas.2026.106281","url":null,"abstract":"<p><strong>Introduction: </strong>Vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) may cause delayed cerebral ischemia (DCI). Intra-arterial nimodipine (IAN) is used in vasospasms resistant to standard hemodynamic therapy. The effect of IAN on long-term outcomes remains uncertain, particularly in patients requiring repeated infusions.</p><p><strong>Research question: </strong>What are the outcomes of aSAH patients treated with IAN, especially compared to the characteristics of patients undergoing repeated versus single IAN infusions.</p><p><strong>Material and methods: </strong>We retrospectively reviewed all aSAH patients with DCI treated with IAN at a tertiary referral center between 2017 and 2024. Logistic regression was used to identify predictors of unfavorable outcome (modified Rankin Scale scores >2) at 3-6 months.</p><p><strong>Results: </strong>Fifty-two patients (mean age 53 years, 65% female) were included. At 3-6 months, 28 patients (54%) had unfavorable outcomes. After propensity score matching for baseline severity of SAH, repeated IAN was associated with unfavorable outcome compared to single IAN (OR 5.13, 95% CI 1.53-19.35) using Firth's penalized logistic regression. Seven patients (13%) died during the six-month follow-up. Mortality did not differ significantly between single and repeated IAN infusion groups (OR 0.74, 95% CI 0.15-3.44).</p><p><strong>Discussion and conclusions: </strong>In this cohort of aSAH patients with vasospasm-related DCI treated with IAN, repeated IAN was associated with unfavorable outcomes. However, mortality did not differ significantly between single and repeated IAN groups. Earlier treatment was not associated with improved outcomes.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106281"},"PeriodicalIF":2.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13507813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intercontinental aeromedical transfers after decompressive craniectomy for severe traumatic brain injury: Systematic review and evidence-informed fitness-to-fly pathway.","authors":"Deepak Gupta, Vishal Garg, Ritwik Kishore, Rajeev Sharma, Kushagra Pandey, Atin Kumar, Babita Gupta, Kamran Farooque, Anna Teresa Mazzeo","doi":"10.1016/j.bas.2026.106278","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106278","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) sustained abroad creates major clinical, logistical, and psychosocial challenges. Guidance on the timing and safety of aeromedical repatriation after cranial surgery remains inconsistent and largely unvalidated.</p><p><strong>Case description: </strong>A 26-year-old foreign national presented unconscious after a hotel-balcony fall. Computed tomography showed a right frontotemporoparietal acute subdural haematoma with bilateral basifrontal contusions.</p><p><strong>Intervention and outcome: </strong>Following resuscitation, he underwent decompressive craniectomy and haematoma evacuation. After tracheostomy and neurocritical-care stabilization, multidisciplinary coordination was undertaken with his family, insurer, authorities, and receiving centre. Pre-flight assessment confirmed neurological and cardiopulmonary stability, secure airway and ventilation, and absence of pneumocephalus and pneumothorax. Three weeks after surgery, transfer by ventilator-equipped fixed-wing air ambulance was completed without reported complications.</p><p><strong>Systematic review: </strong>A PRISMA 2020-aligned focused review was conducted on aeromedical transfers for patients after decompressive craniectomy for severe TBI. Of 737 records identified, 58 full-text reports were assessed, and twenty-six primary studies were included in the narrative synthesis; eight professional guidance, consensus, and regulatory documents were synthesized separately. Evidence was heterogeneous, comprising mainly retrospective military cohorts, surveys, mechanistic models, and case reports. Secondary physiological insults during transport-not elapsed postoperative time alone-were the recurring risk. Evidence relating intracranial-air volume to deterioration was inconsistent, and no universally safe volume or validated post-craniectomy interval was identified.</p><p><strong>Conclusion: </strong>Long-distance repatriation after decompressive craniectomy may be feasible following structured multidisciplinary assessment, physiological optimisation, exclusion of trapped intracranial or thoracic air, and appropriate cabin-pressure and monitoring strategies. The proposed defer/conditional/ready pathway requires prospective validation.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106278"},"PeriodicalIF":2.7,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13486883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the fourth ventricle - Epidermoid cyst of the conus medullaris on the floor of a ventriculus terminalis (fifth ventricle).","authors":"Micol Colosimo, Friederike Liesche-Starnecker, Ansgar Berlis, Peter Baumgarten, Bastian Stemmer, Bjoern Sommer, Dorothee Mielke, Nadine Lilla","doi":"10.1016/j.bas.2026.106262","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106262","url":null,"abstract":"<p><strong>Background: </strong>Intracranial epidermoid cysts, although rare, are well-documented in the literature. However, spinal epidermoid cysts are even rarer. A comprehensive understanding of these lesions is critical for accurate diagnosis, surgical planning, and management In this study, we present a clinically rare case of an epidermoid cyst in the conus medullaris, discuss the findings against the background of the limited number of cases published to date, and thus provide an initial review of the current literature.</p><p><strong>Case presentation: </strong>A 56-year-old male patient presented to our clinic with a history of progressive claudication symptoms. Neurological examination revealed no motor or sensory deficits. Contrast-enhanced lumbosacral magnetic resonance imaging (MRI) demonstrated a well-circumscribed, intramedullary lesion within the conus medullaris at the level of Th12-L1. CT imaging further confirmed the presence of a hyperdense lesion, with internal calcifications.</p><p><strong>Results: </strong>Following diagnostic confirmation, the patient underwent a posterior midline approach with hemilaminectomy at the L1-L2 level to expose the conus medullaris. Intraoperatively, a well-defined cystic lesion was identified. Microsurgical techniques were employed to carefully open the spinal cord and achieve complete resection of the cyst. Histological examination of the lesion confirmed the diagnosis of an epidermoid cyst. The patient's postoperative course was initially uneventful, with complete regression of pain. However, two weeks later, he developed a severe headache and noticed swelling at the surgical site. MRI revealed a cerebrospinal fluid (CSF) leak. The patient was successfully treated with inpatient admission and placement of a lumbar drainage system. One week later, he was discharged without complications and had fully recovered. Apart from our case, a thorough literature review identified only two other reported cases of intramedullary epidermoid cysts (and another intradural extramedullary epidermoid cyst).</p><p><strong>Conclusion: </strong>Intramedullary epidermoid cysts in the conus medullaris are exceedingly rare, with only a few cases documented to date. Our case adds to the limited body of literature and emphasizes the significance of a correct diagnosis and management of such rare spinal lesions.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106262"},"PeriodicalIF":2.7,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}